<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Batchid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-batchId" class="form-control" name="row[batchId]" type="text" value="{$row.batchId|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Serial')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-serial" class="form-control" name="row[serial]" type="text" value="{$row.serial|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Packageid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-packageID" class="form-control" name="row[packageID]" type="text" value="{$row.packageID|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-number" class="form-control" name="row[number]" type="number" value="{$row.number|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[mobile]" type="text" value="{$row.mobile|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Idcard')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-idCard" class="form-control" name="row[idCard]" type="text" value="{$row.idCard|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Policyno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-policyNo" class="form-control" name="row[policyNo]" type="text" value="{$row.policyNo|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agencycode')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agencyCode" class="form-control" name="row[agencyCode]" type="text" value="{$row.agencyCode|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Carno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-carNo" class="form-control" name="row[carNo]" type="text" value="{$row.carNo|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Framecode')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-frameCode" class="form-control" name="row[frameCode]" type="text" value="{$row.frameCode|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Purchaseprice')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-purchasePrice" class="form-control" step="0.01" name="row[purchasePrice]" type="number" value="{$row.purchasePrice|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clientid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clientId" class="form-control" name="row[clientId]" type="text" value="{$row.clientId|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Timestamp')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-timestamp" class="form-control" name="row[timestamp]" type="number" value="{$row.timestamp|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Token')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-token" class="form-control" name="row[token]" type="number" value="{$row.token|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Datefrom')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dateFrom" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[dateFrom]" type="text" value="{$row.dateFrom}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Dateto')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-dateTo" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[dateTo]" type="text" value="{$row.dateTo}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Create_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-create_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[create_time]" type="text" value="{$row.create_time}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
